Help! We Are Pregnant and Insurance Will Not Cover Pregnancy!

Updated on January 04, 2011
D.M. asks from Stephens City, VA
19 answers

I live in Virginia, Front Royal. I have an insurance plan that had me on a 6 month wait to get pregnant before they would cover it. I am al 5.5 months and just found out I am pregnant! Ugh! I am freaking out because while I am going to apply for medicaid - it looks like I make too much money. We are a 5 person household and my husband makes about 60,000 a year. I will have to have a c-section so I know it will be expensive. My OB makes you pay ahead $800 and then make monthly payments. I cannot get $800 dollars! Its crazy that the income requirements are so low - it cost ALOT of money to have a baby, how can we afford this? We can't. My husband is all mad (not at me of course b/c we where using condoms) but he is making me all upset and I can't relax. I would try to get a job as a nanny and bring the kids(I used to ba nanny and a preschool teacher), but I have tried that before and no one wants you to bring your kids, and who wants a pregnant nanny? I am so worried. Has anyone gotten medicaid even though they where above the income requirements? Any suggestions for me? Thank you so much!

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So What Happened?

Well, we cannot just wait a month because our insurance will consider it a pre-existing condition. And I am not surprised by the cost of having a baby, I have two and I know how much it costs. I am surprised that the income requirements are so low considering the cost of having a baby. I have already checked and we can save $800 dollars by the 12 week mark for the first appointment if we really penny pinch, so thats good to know. I am worried about how much the OB will wan't each month but we will have to see. I am sure I will be able to find some solution, but I am looking for ideas so I can look at all possibilites. Right now I have talked to my husbands work insurance agent about getting on that plan, I can, but there is a $5,000 deductible, so it will be expensive still. I called my OB and hospital to talk about the possible payment options and it seems I can make monthly payments. There is CHIP and FAMIS to try for if I am denied for medicaid - and also there is a step down or something plan for medicaid where you pay a deductible each month. So, hopefully I can get something that will work. I am just trying to get a solution soon so I do not worry myself into a miscarriage or something. I have an anxiety disorder and have miscarried before - its hard for me to relax. And just know that I did not plan on getting pregnant!! We where using condoms but it seems that pre mature ejaculation must have gotten me pregnant.

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answers from Austin on

Why do you have to have a c-section? If the only reason is because you have had one before then that is not a reason to have another one. It is safer and healthier for you to have a VBAC rather than another c-section. You should look into midwifery care and homebirth. It is much cheaper than the hospital route.


2 moms found this helpful

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answers from Pittsburgh on

I'm a bit taken aback at the solutions that include lying, divorcing and "working the system"!
You're pregnant (congratulations) now take the steps to find out what you need to do that works best for you.
•call your human services department and see what, if any, help is available.
• you have about 3.5 months to make & save $800. That's not UNdo-able. That's about $50 per week.
•After that, you make the payments.
•Work in a daycare somewhere.
•This is a "bootstraps" situation. Pull yourself up by your own bootstraps.

Honestly, I'm surprised at how many women "get pregnant" and are so surprised at the expense involved. That's the are expensive...from beginning to end! Good luck!

8 moms found this helpful


answers from Dallas on

you've got some great suggestions, but if all else fails........

At worst case scenario........ you will pay this off, like a car or a house. Keep telling yourself this. We ended up in a bad situation as you are with a sick child and had piled up medical bills. It took awhile, but we paid everything remind yourself of this.

Consider a stay at home business (I do this, and so do lots of other mom's on this site) or take in kids for daycare. Don't feel panicked. You can begin all this after you recuperate from giving birth.

You may have to change OB's. See what your city offers.

I know it's scary, but once you have explored all avenues I think you will feel a little better.

3 moms found this helpful


answers from New York on

Medicaid is a government program that is heavily regulated and there are no exceptions.

I would strongly suggest scheduling an appointment with the billing department at both your OBGYN and the hospital where you will deliver. If you tell them upfront that you will need to make payments they are more likely to work with you. You have 4 months to save $$$, so start pinching pennies.

Call the insurance company and find out exactly what their policy is. You say that you have to wait 6 months to get pregnant, but I think that means you have to be on their plan for six months before they will cover major expenses (very common). Many will work with you if you talk with an agent directly.

It is kind of silly for you to attempt to get a nanny job at this point... honestly I wouldn't hire someone who would need to take a leave within a few months AND who would need to bring her young children.

Worst case scenario, talk to the loan officer at your bank and see if you can take out a personal loan to cover the costs.

Be open and honest with the providers and see what they may be willing to do.

2 moms found this helpful


answers from Honolulu on

It could be that you will have pregnancy insurance in .5 months. I had a fried that had a 2 year wait and she got pregnant at 1 month until the coverage began. She was not covered the 1st month but the rest was picked up by the insurance co. Check your policy.

1 mom found this helpful


answers from Norfolk on

Couldn't you just wait a few weeks to get to the 6th month point and then tell your insurance you just found out?

1 mom found this helpful


answers from Los Angeles on

OK, this might not be of real help but in case you get TRULY desperate... my husband and I always joked around that we should get divorced (on paper) so that I would qualify for governmental assistance being a single mother. If your husband is the only one bringing in cash and you're pregnant with kids, you would definitely qualify. You might even qualify now...60k for a family of 5 doesn't sound like it's much and you being pregnant might make the difference of being eligible for health insurance. Look into it. But in case you don't... there's always the paper divorce. And then get remarried when you've had the baby ;p

1 mom found this helpful


answers from New York on

Here in NJ, if you make too much money to qualify for medicaid, you can pay for all your OB appts by using a sliding scale based on your household income. You can only see certain docotors (like a HMO plan) but the payments are affordable and reasonable. Call your countys human services department and tell them your situation. They should be able to guide you.

1 mom found this helpful


answers from Washington DC on

I would wait until a week after the 6m mark and then schedule the dr. appt. I think insurance will cover it if you don't have the first dr. appt. before the 6m mark.

As for assistance, look into the WIC program, once the 6m mark is up. It helps supply food for Woman, and Children from birth to 5y.

Look into a midwife delivery. Also check out the Health Department. They offer some medical checkups and such at discounts.

I don't know what Warren County Hospital's policy is, you could look into it, but Prince William (Manassas) is a community hospital. Which means that if you arrive in labor, they cannot turn you away for not having insurance.

Congrats and good luck.



answers from Columbus on

I don't much about Medicaid but my BIL's ex didn't have insurance when she was pregnant and she found a clinic with our local hospital that covered her pregnancy and delivery 100%. You wouldn't be able to go to your normal OB but if you can't afford it, then it might be your only option. I would call your local hospitals and see if they have women's clinics.



answers from San Francisco on

I don't know if its just available in California...but there is a Health Insurance program for pregnant women who don't qualify for Medicaid its called AIM...I think its through Blue Cross and even Blue Shield offers a similar program.

My suggestion is to go ahead and call your Medicaid office and apply. They may deny you for Medicaid but there might be a separate program just for pregnancy like CA's AIM...If not you can always move out this way! Just kidding of course! I'm sure there are some other resources out there for you. Hang in there, Mamas on mamapedia always seem to come through for me!

Wish you all the best!

EDIT: I briefly did a google search and saw it seems like VA does offer a program similar to CA's AIM, and you're family is calling it close for the income requirements. Might be worth a call anyway

Oops just read your update and it seems your aware of this program. It works real well in CA! Just don't forget to count your unborn baby as a dependent. Call get your application in, and continue to explore all your options. Doesn't hurt to try right!


answers from Dallas on

Don't go to the doctor until after the waiting period is over. You only have another half of a month to go. Then, the insurance company will cover it. Problem solved. Right?



answers from Chicago on

Illinois also has a special program to provide health care just for mothers and children who do not have insurance. It also covers pregnant women- not sure if your husband's insurance status would make you ineligible, but it is certainly worth checking to see if your state has it. In IL it was called KidCare, I think. But it is only for pregnant women, mothers and children.



answers from Atlanta on

Regardless of what happens with all of this, I read that you didn't plan on getting pregnant but are only using condoms. Consider a permanent option -vasectomies are fairly cheap -or at least an IUD after this baby so you don't have to worry about this any more.

Google and check around about pregnancy insurance. I have no idea what all it entails or costs, but I have heard of it and of women using it in your situation.



answers from Boston on

Here in ma if you make too much you have the option to pay for medicaid insurance. You could judt wait a few weeks before you call the ob and your insurance. I didn't have my first ob appt until I was 8 weeks along I think that was their policy unless you were high risk.
It might look like you make too much but they may have certain plans for women in your shoes. Also check with the finance dept at the hospital you will deliver at. Some have programs that offer lab tests, stays, ultrasound etc at a reduced/no cost and the income level is usually higher then what medicaid has set. Are you counting your baby in your family size for Medicaid? Thet generally count your baby as a family member if you are pregnant. It's almost tax time save your tax return to help with the cost.



answers from Phoenix on

I had this situation with my first and waited until the 6 month wait period to go to the doctor. I had them run a test as if I didn't know I was pregnant. So to the Dr. & insurance I didn't find out until after the wait period and everything was covered.

If not, like the other ladies said you make payments. We too found ourselves with a sick child and hubby with no job. We are still paying it off but it can be done.

***Added...Do you have a planned parent hood near you? They offer OB services and many times can do it for a "donation" type basis that is much smaller than Dr fees. i have used this on between insurances for BC and preggo tests.

Take a deep breath.



answers from Lincoln on

Getting Medicaid specifically for a pregnancy sometimes has totally different requirements. So there may still be hope there.
Have you had this pregnancy verified by a doctor yet? If not, wait 2 weeks. Call your OB after the 6 month waiting period to make an appointment and ask them to get pre-authorization with your insurance to make sure its covered. Chances are it will be. Relax, it will work out.



answers from Portland on

Does Virginia offer a lower-cost state sponsored health insurance? I know this is offered in Oregon; it's on a lottery system here right now, but perhaps because you are pregnant, you'll get priority.

What a difficult situation-- I do hope you find the coverage you need.



answers from Chicago on

I know its hard to switch doctors, but maybe you can find a different one that will work with you on the payments? I think most doctors office can work with you on a payment plan. They can't expect you to just give that all up front. That's ridiculous! I hope you can figure it out!

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